| Sacred Ground Institute Llc | |
|
140 Captain Thomas Blvd Ste 211b West Haven CT 06516-5951 | |
| (203) 927-0042 | |
| Not Available |
| Full Name | Sacred Ground Institute Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 140 Captain Thomas Blvd Ste 211b, West Haven, Connecticut |
| Authorized Official Name and Position | Tawanna Woolfolk (OWNER) |
| Authorized Official Contact | 2039270042 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sacred Ground Institute Llc 140 Captain Thomas Blvd Ste 211b West Haven CT 06516-5951 Ph: () - | Sacred Ground Institute Llc 140 Captain Thomas Blvd Ste 211b West Haven CT 06516-5951 Ph: (203) 927-0042 |
| NPI Number | 1679281588 |
|---|---|
| Provider Enumeration Date | 11/09/2022 |
| Last Update Date | 11/09/2022 |
| Certification Date | 11/09/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679281588 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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